The Public Option – Individual Mandate Two-step
posted at 9:02 am on August 17, 2009 by Karl
Michelle Malkin thinks that the Obama administration’s softening on its proposed government-run health insurance plan is more a trial balloon than a white flag. Indeed, this weekend’s statements were not all that newsworthy. As Marc Ambinder correctly notes, Rahm Emanuel has known for months that even a neutered public plan with a trigger mechanism did not have the votes to pass. The administration will likely be forced to sneak in public insurance under the rubric of co-ops.
However, the latest “trial balloon” here was likely an unintentional blunder. The public opinion polling on ObamaCare — particularly its more high-profile elements — now generally takes the form of “Democrats support it, but not Republicans or unaffiliated voters.” Many on the Left equate healthcare reform with the “public option” trojan horse (and are suspicious of the co-op trojan horse), so to ditch it now would cause support for their campaign to crater. The Democrats simply cannot afford to abandon the government-run plan so soon.
The other big reason the Democrats cannot ditch the “public option” yet is precisely because it would allow ObamaCare critics to concentrate their fire on other key elements of their plan. That includes the co-op idea, though it should be fairly easy to discredit as the “public option in sheep’s clothing.” In the medium-term, it may be more significant that the “public option” helps the Democrats deflect fire from the individual mandate.
First, the basic outline of Obamacare can survive ditching the public option. It can’t survive ditching the individual mandate. You can’t, for example, have a ban on insurers’ taking account of pre-existing conditions without such a mandate.
Second, the polling on an individual mandate suggests that it’s less popular than the public option — and just plain unpopular. I keep pointing out that Obama was able to win the Democratic presidential primaries without embracing a mandate, which ought to tell us something about the politics of the issue.
Third, my impression from talking to Republican congressmen about the issue is that to the extent they support this idea, that support is an inch deep. It rests on misunderstandings that are easy to clear up (notably the notion that a mandate would reduce insurance premiums by making the uninsured pay their fair share).
Fourth, we have already made our case on the public option, and we haven’t made it on the mandate.
Fifth, there are interest groups willing to keep making the case on the public option — but most of these interest groups are for the mandate since it would improve their bottom lines (at least in the short term).
Ponnuru is not entirely correct on all of those points. The Right needs to keep the heat on the “public option” — as toppling it would greatly demoralize the Democrats — but the Right also needs to start attacking the individual mandate. Though you can find polls like Quinnipiac that show opposition, you can find recent polls (e.g., Gallup and Pew) supporting the individual mandate. However, as with the politicians, that support is about an inch deep. The individual mandate gets very bad numbers if people are told there will be fines for those who do not buy insurance (EBRI and NBC/WSJ) or that some could be required to buy insurance they cannot afford or do not want (KFF). And there is a real-world example of these problems with the individual mandate:
Massachusetts has a mandate right now. They have exempted 20 percent of the uninsured because they have concluded that that 20 percent can’t afford it.
In some cases, there are people who are paying fines and still can’t afford it, so now they’re worse off than they were. They don’t have health insurance and they’re paying a fine.
That was candidate Barack Obama’s opinion. The Right needs to remind the public of this early and often.